Prostate Cancer. Test 5 – Flashcards
Unlock all answers in this set
Unlock answersquestion
Prostate cancer significance
answer
1:5 men will develop it in their lifetime; only 1:34 will die from it
question
What is the most common cancer in men excluding skin cancer?
answer
Prostate Cancer
question
Second leading cause of cancer death in men?
answer
Prostate Cancer
question
More than 75% of cases develop in men of what ages?
answer
Men over 65 yrs of age
question
Etiology and pathophysiology of prostate cancer?
answer
Malignant tumor of prostate gland
question
What kind of cancer is prostate cancer?
answer
Androgen-dependent adenocarcinoma
question
Where do majority of tumors occur in prostate cancer?
answer
Outer aspect of the gland
question
Does prostate cancer grow slow or fast
answer
Usually slow growing
question
Non-modifiable risk fx to prostate cancer
answer
Age Ethnicity Family hx
question
What race has highest incidence of Prostate cancer
answer
African Americans (2x whites)
question
What increases risk of men to get prostate cancer?
answer
1st degree relative w prostate cancer
question
Finasteride indicated that what was reduced for men?
answer
Men had a reduced chance of getting prostate cancer by 25% in a trial when taking finasteride
question
What kind of a diet will increase risk of prostate cancer
answer
Diet high in red meat, high fat, low intake of fruits and veggies can increase risk
question
What in diet may reduce risk of prostate cancer and what is it found it
answer
Lycopene: found in tomatoes, apples, watermelon
question
Hx of BPH, does it predispose to cancer
answer
No. It doesn't predispose to prostate cancer
question
Symptoms of Prostate cancer early on
answer
Usually asymptomatic in early stages Eventually symptoms similar to BPH
question
S/S of prostate cancer
answer
Dysuria Frequency Hesitancy Urgency Dribbling Hematuria Nocturia Rentention Interruption of urinary stream Inability to urinate
question
Where does prostate cancer like to metastasize to?
answer
The bone
question
Pain where could indicate metastasis in prostate cancer?
answer
Pain in lumbosacral area that radiates to hips or legs could indicate metastasis
question
Where can tumor of prostate cancer spread to?
answer
Tumor can spread to pelvic lymph nodes, bones, bladder, lungs, and liver
question
What becomes problem once cancer has spread to distant sites?
answer
Pain management
question
Diagnostic studies for prostate cancer?
answer
PSA blood test: Normal level 0-4 ng/ml
question
What do elevated levels of PSA indicate?
answer
They indicate prostatic pathology, not necessarily cancer just means something is going on
question
What can cause PSA to be mildly elevated?
answer
BPH Prostatitis Older age Prostate procedures Recent ejaculation Long bike rides
question
What is PSA level also used to monitor?
answer
Monitors success of treatment
question
What is PAP?
answer
Prostatic Acid Phosphatase
question
What does PAP indicate?
answer
It can also indicate prostate cancer. Indicates bone metastasis
question
What will DRE be like in prostate cancer?
answer
May find prostate hard and have asymmetric enlargement with areas of induration or nodules
question
What tests ARE NOT definitive diagnostic tests?
answer
PSA or DRE aren't definitive diagnostic test
question
What is necessary to confirm diagnosis of prostate cancer?
answer
Biopsy of prostate tissue
question
How is biopsy of tissue done and what does it allow for?
answer
Using a transrectal ultrasound (TRUS) to allow physician to visualize and pinpoint abnormalities
question
When should you do watchful waiting in prostate cancer?
answer
When Life expectancy is less than 10 yrs Presence of low grade, low stage tumor
question
What should be done frequently for prostate cancer?
answer
PSA levels along w/a DRE to monitor for any changes
question
What are two common staging systems
answer
Whitmore-Jewett TNM classification system
question
What do both staging systems use
answer
Size of tumor and spread of Ca to stage: A, B, C, D
question
What does Gleason scale grade?
answer
Cell type on scale 2-10 and predicts how quickly the cancer will progress
question
Surgical therapy for prostate cancer
answer
Radical prostatectomy Nerve sparing procedure Cyrosurgery Radiation therapy Orchiectomy Chemo
question
Radical prostatectomy
answer
Takes entire gland, seminal vesicles, and part of bladder neck are removed
question
What else is done w/radical prostatectomy and why?
answer
Retroperineal lymph node dissection (removal). Biopsy to see if cancer has spread.
question
What is most effective for long term survival of prostate cancer?
answer
Radical prostatectomy
question
What issues may man have w/radical prostatectomy?
answer
ED and urinary incontinence b/c of swelling
question
Pt catheterized for how long after radical prostatectomy
answer
1-2 wks
question
Complications of radical prostatectomy
answer
Hemorrhage (lots of blood vessels in area) Urinary retention Infection Wound dehiscence DVT Pulmonary emboli
question
Any surgery that occurs below belly button pt at risk for what
answer
DVT and pulmonary emboli b/c large veins lie below the waist
question
Nerve sparing procedure usually done when
answer
Surgical procedure- during a radical prostatectomy
question
What does nerve sparing procedure do?
answer
Spares nerves responsible for erection
question
Nerve sparing procedure is not indicated for pts who what?
answer
Have cancer outside of the prostate gland
question
There is no guarantee for what in nerve sparing procedure?
answer
Potency will be maintained
question
Cyrosurgery (Cryoablation)
answer
Destroys cancer cells by FREEZING the tissues
question
Cryosurgery is what tx after what fails?
answer
Inital and second line treatment after radiation therapy fails
question
What does Transrectal ultrasound probe do in cyrosurgery?
answer
Delivers liquid nitrogen into tissues
question
How long does cyrosurgery take and what anesthesia is it done under?
answer
It takes about 2 hrs- spinal or general anesthesia No abdominal incision
question
Radiation therapy
answer
External Beam Radiation Brachytherapy
question
External Beam radiation
answer
Used to treat cancer confined to prostate and or surrounding tissue
question
What stages is external beam radiation used for?
answer
Cancer of stages A, B, C
question
SE of external beam radiation. Can be acute or delayed
answer
Skin irritation GI/GU symptoms ED Fatigue
question
Brachytherapy- internal
answer
Implantation of radioactive seed into prostate gland Spares surrounding tissue
question
How is placement of radioactive seeds done in brachytherapy?
answer
Placement guided by transrectal ultrasound, use needle to place seeds Done under anesthesia, outpatient procedure
question
How long do seeds stay in prostate?
answer
Seeds stay in for the rest of mans life. Become inactive after a certain amount of time. No one else is at harm or exposed to the radiation.
question
Brachytherapy is best suited for what stages of cancer?
answer
Stages A and B
question
Common SE of brachytherapy
answer
Irritative or obstructive urinary problems
question
For advanced tumors what can bracytherapy be used with?
answer
Can be used in addition to external beam radiation for advanced tumors
question
Hormonal Therapy for prostate cancer?
answer
Androgen deprivation therapy
question
What does androgen deprivation therapy focus on and when can it be used?
answer
Reducing the levels of androgens in order to reduce tumor growth Used before surgery or radiation to reduce tumor size
question
What male hormone feeds prostate cancer?
answer
Androgen feeds prostate cancer. Male hormone
question
Types of hormonal therapy
answer
Luteinizing hormone releasing hormone agonists Androgen receptor blockers
question
Luteinizing hormone releasing hormone agonists examples and SE's?
answer
leuprolide: IM injection q 1-3 months SE: Hot flashes, ED, low libido, gyenecomastia
question
Androgen Receptor blockers
answer
bicalutamide: pill given w/LH-RG agonists SE: hot flashed, ED, low libido, gynecomastia
question
What does the two types of hormonal therapy do to the body?
answer
Reduce the amount of testosterone in body
question
Orchiectomy
answer
Surgical removal of tested for advanced stages of prostate cancer.
question
Orchiectomy is for what stage of cancer
answer
Stage D cancer
question
What does orchiectomy do to the body?
answer
Removes 90% of circulating testosterone. Eliminate whats feeding cancer
question
SE of orchiectomy
answer
Hot flashes ED Loss of libido Irritability Weight gain Osteoporosis Loss of muscle mass
question
Chemotherapy
answer
Primarily limited to tx for those w/hormone resistant prostate cancer in late stages
question
If prostate cancer responds poorly to chemo what is the goal
answer
Palliative care
question
Example of chemo drug?
answer
docetaxel
question
What do Bisphosphonates do
answer
Prevent and tx bone complications in advanced cancer Given to women w/osteoporosis. Moves Ca+ out of bloodstream back into bones
question
Bisphosphonate exapmles?
answer
risendronate, alendronate
question
What should nurses encourage for management/implementation?
answer
DRE and PSA screenings. Annually at age 50, or younger if risk fx.
question
What should be taught?
answer
Catheter care (cleanse around meatus daily) Keep bag lower than bladder Push fluids Watch for infection Teach pelvic floor exercises (Kegels)- helps w/urinary incontinence Administer pain meds
